同性恋或双性恋女性与异性恋女性相比更容易过早死亡

美国哈佛大学Brittany M. Charlton团队研究了大型前瞻性女护士队列中性取向死亡率的差异。这一研究成果发表在2024年4月25日出版的《美国医学会杂志》上。

大量证据表明，女同性恋、男同性恋和双性恋（LGB）女性的健康状况存在差异，包括身体、心理和行为健康状况比异性恋女性差。这些因素与过早死亡有关，但很少有研究调查LGB女性过早死亡的差异，以及她们是否因女同性恋或双性恋身份而不同。

为了探讨性取向对死亡率的影响，研究组进行了一项前瞻性队列研究，检查了不同性取向的死亡时间差异，并根据出生队列进行了校正。参与者是1945年至1964年出生的女护士，最初于1989年在美国招募参加护士健康研究II，并随访至2022年4月。1995年评估了性取向（女同性恋、双性恋或异性恋）。主要结局为使用加速失效时间模型分析暴露评估的全因死亡时间。

在116149名符合条件的参与者中，90833人（78%）拥有有效的性取向数据。在这90833名参与者中，89821人（98.9%）被认定为异性恋，694人（0.8%）被认定是女同性恋，318人（0.4%）被认为是双性恋。在报告的4227例死亡中，大多数是异性恋参与者（n = 4146；累计死亡率4.6%），其次是女同性恋参与者（n = 49；累计死亡率为7.0%）和双性恋参与者（n = 32；累计死亡率10.1%）。与异性恋参与者相比，LGB参与者的死亡时间更早（校正后的加速因子，0.74[95%CI，0.64-0.84]）。这些差异在双性恋参与者中最大（校正后的加速因子，0.63[95%置信区间，0.51-0.78]），其次是女同性恋参与者（校正后加速因子，0.80[95%可信区间，0.68-0.95]）。

研究结果表明，在其他方面基本相同的女护士样本中，与异性恋女性相比，被认定为女同性恋或双性恋的参与者在研究期间的死亡时间明显更早。这些死亡时间的差异凸显了解决可改变的风险传播和延续差异的上游社会力量的紧迫性。

附：英文原文

Title: Disparities in Mortality by Sexual Orientation in a Large, Prospective Cohort of Female Nurses

Author: Sarah McKetta, Tabor Hoatson, Landon D. Hughes, Bethany G. Everett, Sebastien Haneuse, S. Bryn Austin, Tonda L. Hughes, Brittany M. Charlton

Issue&Volume: 2024-04-25

Abstract:

Importance  Extensive evidence documents health disparities for lesbian, gay, and bisexual (LGB) women, including worse physical, mental, and behavioral health than heterosexual women. These factors have been linked to premature mortality, yet few studies have investigated premature mortality disparities among LGB women and whether they differ by lesbian or bisexual identity.

Objective  To examine differences in mortality by sexual orientation.

Design, Setting, and Participants  This prospective cohort study examined differences in time to mortality across sexual orientation, adjusting for birth cohort. Participants were female nurses born between 1945 and 1964, initially recruited in the US in 1989 for the Nurses’ Health Study II, and followed up through April 2022.

Exposures  Sexual orientation (lesbian, bisexual, or heterosexual) assessed in 1995.

Main Outcome and Measure  Time to all-cause mortality from assessment of exposure analyzed using accelerated failure time models.

Results  Among 116149 eligible participants, 90833 (78%) had valid sexual orientation data. Of these 90833 participants, 89821 (98.9%) identified as heterosexual, 694 (0.8%) identified as lesbian, and 318 (0.4%) identified as bisexual. Of the 4227 deaths reported, the majority were among heterosexual participants (n=4146; cumulative mortality of 4.6%), followed by lesbian participants (n=49; cumulative mortality of 7.0%) and bisexual participants (n=32; cumulative mortality of 10.1%). Compared with heterosexual participants, LGB participants had earlier mortality (adjusted acceleration factor, 0.74 [95% CI, 0.64-0.84]). These differences were greatest among bisexual participants (adjusted acceleration factor, 0.63 [95% CI, 0.51-0.78]) followed by lesbian participants (adjusted acceleration factor, 0.80 [95% CI, 0.68-0.95]).

Conclusions and Relevance  In an otherwise largely homogeneous sample of female nurses, participants identifying as lesbian or bisexual had markedly earlier mortality during the study period compared with heterosexual women. These differences in mortality timing highlight the urgency of addressing modifiable risks and upstream social forces that propagate and perpetuate disparities.

DOI: 10.1001/jama.2024.4459